The proposed Mentored Patient-Oriented Research Career Development (K23) award application describes a program of training and research focused on developing the skills necessary for the candidate to reach her long-term goal of conducting clinical trials of culturally relevant, psychosocial interventions for unipolar depression in low-income, African American and European American older adults in community-based settings. Charlotte Brown, Ph.D., Clinical Psychologist and Associate Professor of Psychiatry at the University of Pittsburgh School of Medicine will serve as mentor, and Charles F. Reynolds, III, MD, Psychiatrist and Professor of Geriatric Psychiatry at the University of Pittsburgh School of Medicine will serve as co-mentor. A program of career development is planned which will provide training in clinical interventions research methodology, advanced statistical analyses and conceptual issues in conducting mental health services research necessary to enable the candidate to implement a successful independent research career focused on refining interventions to successfully engage and retain low-income older adults in multi-session psychosocial interventions for depression. Late life depression is prevalent among low-income older adults, and is associated with reduced quality of life, and increased morbidity and mortality. Despite effective treatments for depression among older adults, few seek mental health services, engage in treatment and stay in treatment for the prescribed length of time. Many older adults express a preference for psychotherapy;however, when older adults receive a referral to mental health care they are not likely to make an appointment for treatment, suggesting that barriers exist which deter older adults from initiating and engaging in their preferred treatment. Stigma is a major public health concern, has been identified as a significant psychological barrier to mental health service utilization and predicts treatment discontinuation among older adults with depression. The proposed project involves the development of a stigma reduction intervention for older adults (aged 65+) with depression to enhance their engagement and retention in an evidence-based multi-session psychosocial treatment. The proposed intervention contains two components, a novel engagement intervention provided by Peer Educators followed by an enhanced course of cognitive behavioral therapy (CBT). The overall objective of the proposed intervention is to develop an integrated intervention strategy that reduces significant barriers to treatment engagement and retention, is aligned with the cultural values of older ethnic minorities, can be sustained in the community and extends the benefit of an evidence-based practice by enhancing the ability to reach those most in need. It is hypothesized that the proposed engagement intervention integrated with an enhanced course of CBT will (1) reduce internalized stigma associated with receiving treatment, (2) improve treatment engagement and retention for older adults with depression, and (3) decrease depressive symptoms.

Public Health Relevance

New strategies are needed to successfully engage and treat disadvantaged older adults suffering from depression. The proposed project will lead to the development of an integrated intervention strategy (i.e. an engagement intervention provided by Peer Educators, followed by an enhanced course of cognitive behavioral therapy) that reduces significant barriers to treatment engagement and retention, is aligned with the preferences and cultural values of disadvantaged older adults, can be sustained in community-based settings and extends the benefit of an evidence-based practice by reaching those most in need.